Senior analyst jobs in Grand Island, NE

Hastings College seeks a Systems Analyst to drive the development and optimization of cutting-edge systems solutions. If you're passionate about technology and seek a dynamic role in a collaborative environment, this is the opportunity for you. Why Join Hastings College? Join Hastings College and help shape the future of a dynamic and forward-thinking institution. As a Systems Analyst, you will play a key role in supporting and enhancing the technological infrastructure of the college and collaborating with various departments to meet software workflow needs. In addition to traditional benefits, we offer a comprehensive benefits package designed to support our employees' well-being and professional growth. We provide a free individual membership to the Hastings YMCA, up to 15 paid holidays per year in addition to up to three weeks of vacation allowing for a health work-life balance. Additionally, we support lifelong learning through our tuition remission program, where employees can take up to two courses per semester, and dependents are also eligible for tuition remission. While we value the benefits of hybrid work, we are seeking an individual who can be primarily on-site at our Hastings College campus. To ensure a successful onboarding experience, the selected candidate will be expected to work fully on-site for the first 3 months. After this initial period, a hybrid work schedule may be possible to support a successful work-life balance. Job Summary: Develop, optimize, and maintain SQL code and PowerShell scripts for efficient system automation. Engineer ETL processes for seamless data transformation and integration. Create and manage operational reports using BI platforms to ensure data integrity. Provide essential support for vendor software updates, documenting system architecture changes. Serve as a technical liaison, troubleshooting vendor package issues and facilitating communication. Interpret user requirements, offer technical support, and maintain strong business metric understanding. Collaborate with vendors, adapt to new technologies, and represent the institution professionally. View the job description for a full list of duties. Education & Experience: Bachelor's degree from four-year college or university in computer science, information systems, operations research, or a related field and at least two years of related experience; or equivalent combination of education and experience. Experience working with T-SQL, MySQL, or other query language required. Experience with the following is desired: SSRS, SQL Integration Services, Azure Data Factory, MSSQL Databases, PowerShell, Python, or PowerBI. Equal Opportunity Employment Hastings College is committed to supporting a welcoming academic and employment environment. The College is an Equal Opportunity employer that does not discriminate on the basis of race, ethnicity, color, national origin, religion, age, sex, marital status, pregnancy, sexual orientation, gender identity, genetic information, disability, veteran status, or any other characteristic protected by local, state, or federal laws. Apply now to join our team dedicated to optimizing technology solutions at Hastings College.

Provides senior level analyst support for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. Essential Job Duties * Extracts and compiles data and information from various systems to support executive decision-making. * Mines and manages information from large data sources. * Analyzes claims and other data sources to identify early signs of trends or other issues related to medical care costs. * Analyzes the financial performance, including cost, utilization and revenue of all Molina products - identifying favorable and unfavorable trends, developing recommendations to improve trends and communicating recommendations to leadership. * Draws actionable conclusions based on analyses performed, makes recommendations through use of health care analytics and predictive modeling, and communicates those conclusions effectively to audiences at various levels of the enterprise. * Performs pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives. * Collaborates with clinical, provider network and other teams to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. * Collaborates with business owners to track key performance indicators of medical interventions. * Proactively identifies and investigates complex suspect areas regarding medical cost issues, initiates in-depth analysis of suspect/problem areas and suggests corrective action plans. * Designs and develops reports to monitor health plan performance and identify the root causes of medical cost trends - with root causes identified, drives innovation through creation of tools to monitor trend drivers and provides recommendations to senior leaders for affordability opportunities. * Leads projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports. * Serves as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes * Provides data driven analytics to finance, claims, medical management, network, and other departments to enable critical decision making. * Supports financial analysis projects related to medical cost reduction initiatives. * Supports medical management by assisting with return on investment (ROI) analyses for vendors to determine if financial and clinical performance is achieving desired results. * Keeps abreast of Medicaid and Medicare reforms and impact on the Molina business. * Supports scoreable action item (SAI) initiative tracking to performance. Required Qualifications * At least 3 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience. * Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field. * Demonstrated understanding of Medicaid and Medicare programs or other health care plans. * Analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Proficiency with retrieving specified information from data sources. * Experience with building dashboards in Excel, Power BI, and/or Tableau and data management. * Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Knowledge of health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). * Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. * Understanding of value-based risk arrangements * Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. * Ability to mine and manage information from large data sources. * Demonstrated problem-solving skills. * Strong critical-thinking and attention to detail. * Ability to effectively collaborate with technical and non-technical stakeholders. * Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Proficient in Microsoft Office suite products, key skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. Preferred Qualifications * Proficiency with Power BI and/or Tableau for building dashboards. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $77,969 - $155,508 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Hastings College seeks a Systems Analyst to drive the development and optimization of cutting-edge systems solutions. If you're passionate about technology and seek a dynamic role in a collaborative environment, this is the opportunity for you. Why Join Hastings College? Join Hastings College and help shape the future of a dynamic and forward-thinking institution. As a Systems Analyst, you will play a key role in supporting and enhancing the technological infrastructure of the college and collaborating with various departments to meet software workflow needs. In addition to traditional benefits, we offer a comprehensive benefits package designed to support our employees' well-being and professional growth. We provide a free individual membership to the Hastings YMCA, up to 15 paid holidays per year in addition to up to three weeks of vacation allowing for a health work-life balance. Additionally, we support lifelong learning through our tuition remission program, where employees can take up to two courses per semester, and dependents are also eligible for tuition remission. While we value the benefits of hybrid work, we are seeking an individual who can be primarily on-site at our Hastings College campus. To ensure a successful onboarding experience, the selected candidate will be expected to work fully on-site for the first 3 months. After this initial period, a hybrid work schedule may be possible to support a successful work-life balance. Job Summary: * Develop, optimize, and maintain SQL code and PowerShell scripts for efficient system automation. * Engineer ETL processes for seamless data transformation and integration. * Create and manage operational reports using BI platforms to ensure data integrity. * Provide essential support for vendor software updates, documenting system architecture changes. * Serve as a technical liaison, troubleshooting vendor package issues and facilitating communication. * Interpret user requirements, offer technical support, and maintain strong business metric understanding. * Collaborate with vendors, adapt to new technologies, and represent the institution professionally. View the job description for a full list of duties. Education & Experience: Bachelor's degree from four-year college or university in computer science, information systems, operations research, or a related field and at least two years of related experience; or equivalent combination of education and experience. Experience working with T-SQL, MySQL, or other query language required. Experience with the following is desired: SSRS, SQL Integration Services, Azure Data Factory, MSSQL Databases, PowerShell, Python, or PowerBI. Equal Opportunity Employment Hastings College is committed to supporting a welcoming academic and employment environment. The College is an Equal Opportunity employer that does not discriminate on the basis of race, ethnicity, color, national origin, religion, age, sex, marital status, pregnancy, sexual orientation, gender identity, genetic information, disability, veteran status, or any other characteristic protected by local, state, or federal laws. Apply now to join our team dedicated to optimizing technology solutions at Hastings College.

Provides senior level analyst support for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. **Essential Job Duties** - Extracts and compiles data and information from various systems to support executive decision-making. - Mines and manages information from large data sources. - Analyzes claims and other data sources to identify early signs of trends or other issues related to medical care costs. - Analyzes the financial performance, including cost, utilization and revenue of all Molina products - identifying favorable and unfavorable trends, developing recommendations to improve trends and communicating recommendations to leadership. - Draws actionable conclusions based on analyses performed, makes recommendations through use of health care analytics and predictive modeling, and communicates those conclusions effectively to audiences at various levels of the enterprise. - Performs pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives. - Collaborates with clinical, provider network and other teams to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. - Collaborates with business owners to track key performance indicators of medical interventions. - Proactively identifies and investigates complex suspect areas regarding medical cost issues, initiates in-depth analysis of suspect/problem areas and suggests corrective action plans. - Designs and develops reports to monitor health plan performance and identify the root causes of medical cost trends - with root causes identified, drives innovation through creation of tools to monitor trend drivers and provides recommendations to senior leaders for affordability opportunities. - Leads projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports. - Serves as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes - Provides data driven analytics to finance, claims, medical management, network, and other departments to enable critical decision making. - Supports financial analysis projects related to medical cost reduction initiatives. - Supports medical management by assisting with return on investment (ROI) analyses for vendors to determine if financial and clinical performance is achieving desired results. - Keeps abreast of Medicaid and Medicare reforms and impact on the Molina business. - Supports scoreable action item (SAI) initiative tracking to performance. **Required Qualifications** - At least 3 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience. - Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field. - Demonstrated understanding of Medicaid and Medicare programs or other health care plans. - Analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) - Proficiency with retrieving specified information from data sources. - Experience with building dashboards in Excel, Power BI, and/or Tableau and data management. - Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) - Knowledge of health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). - Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. - Understanding of value-based risk arrangements - Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. - Ability to mine and manage information from large data sources. - Demonstrated problem-solving skills. - Strong critical-thinking and attention to detail. - Ability to effectively collaborate with technical and non-technical stakeholders. - Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Proficient in Microsoft Office suite products, key skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. **Preferred Qualifications** - Proficiency with Power BI and/or Tableau for building dashboards. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $77,969 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides senior level analyst support for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. Essential Job Duties * Extracts and compiles data and information from various systems to support executive decision-making. * Mines and manages information from large data sources. * Analyzes claims and other data sources to identify early signs of trends or other issues related to medical care costs. * Analyzes the financial performance, including cost, utilization and revenue of all Molina products - identifying favorable and unfavorable trends, developing recommendations to improve trends and communicating recommendations to leadership. * Draws actionable conclusions based on analyses performed, makes recommendations through use of health care analytics and predictive modeling, and communicates those conclusions effectively to audiences at various levels of the enterprise. * Performs pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives. * Collaborates with clinical, provider network and other teams to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. * Collaborates with business owners to track key performance indicators of medical interventions. * Proactively identifies and investigates complex suspect areas regarding medical cost issues, initiates in-depth analysis of suspect/problem areas and suggests corrective action plans. * Designs and develops reports to monitor health plan performance and identify the root causes of medical cost trends - with root causes identified, drives innovation through creation of tools to monitor trend drivers and provides recommendations to senior leaders for affordability opportunities. * Leads projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports. * Serves as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes * Provides data driven analytics to finance, claims, medical management, network, and other departments to enable critical decision making. * Supports financial analysis projects related to medical cost reduction initiatives. * Supports medical management by assisting with return on investment (ROI) analyses for vendors to determine if financial and clinical performance is achieving desired results. * Keeps abreast of Medicaid and Medicare reforms and impact on the Molina business. * Supports scoreable action item (SAI) initiative tracking to performance. Required Qualifications * At least 3 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience. * Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field. * Demonstrated understanding of Medicaid and Medicare programs or other health care plans. * Analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Proficiency with retrieving specified information from data sources. * Experience with building dashboards in Excel, Power BI, and/or Tableau and data management. * Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Knowledge of health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). * Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. * Understanding of value-based risk arrangements * Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. * Ability to mine and manage information from large data sources. * Demonstrated problem-solving skills. * Strong critical-thinking and attention to detail. * Ability to effectively collaborate with technical and non-technical stakeholders. * Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Proficient in Microsoft Office suite products, key skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. Preferred Qualifications * Proficiency with Power BI and/or Tableau for building dashboards. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $77,969 - $155,508 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides entry level analyst support for clinical information systems activities. Responsible for provision of application technical support and design for clinical information systems - ensuring creation of workflows and enhancements that support process improvement and change management initiatives. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Assists in the development and support of clinical, practice management and operational workflows. - Assists in the design of workflow analysis, device integration, planning and implementation of clinical systems. - Participates in the system implementation life cycle including: planning, implementation, training, and post-implementation support. - Assists in issue resolution related to the clinical information system. Required Qualifications - At least 1 year of system implementation experience, or equivalent combination of relevant education and experience. - Knowledge of systems design methods and techniques. - Knowledge base in health care informatics. - Ability to work independently, within a team and collaboratively across teams. - Analysis, synthesis and problem-solving skills. - Attention to detail and accuracy. - Multi-tasking, planning, and workload prioritization skills. - Verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $42.2 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides entry level analyst support for clinical information systems activities. Responsible for provision of application technical support and design for clinical information systems - ensuring creation of workflows and enhancements that support process improvement and change management initiatives. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Assists in the development and support of clinical, practice management and operational workflows. - Assists in the design of workflow analysis, device integration, planning and implementation of clinical systems. - Participates in the system implementation life cycle including: planning, implementation, training, and post-implementation support. - Assists in issue resolution related to the clinical information system. Required Qualifications - At least 1 year of system implementation experience, or equivalent combination of relevant education and experience. - Knowledge of systems design methods and techniques. - Knowledge base in health care informatics. - Ability to work independently, within a team and collaboratively across teams. - Analysis, synthesis and problem-solving skills. - Attention to detail and accuracy. - Multi-tasking, planning, and workload prioritization skills. - Verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $42.2 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. **JOB DUTIES** + Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. + Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. + Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. + Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. + Where applicable, codifies the requirements for system configuration alignment and interpretation. + Provides support for requirement interpretation inconsistencies and complaints. + Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. + Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. + Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. + Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. **Recoveries & Disputes** + Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. + Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. + Provide actionable insights and recommendations to leadership to drive continuous improvement. **Skills & Competencies** + Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems into clear system requirements and process improvements. + Proficiency in Excel + Knowledge in QNXT preferred + Strong communication and stakeholder management skills with ability to influence across teams. **KNOWLEDGE/SKILLS/ABILITIES** + Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. + Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. + Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. + Ability to concisely synthesize large and complex requirements. + Ability to organize and maintain regulatory data including real-time policy changes. + Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. + Ability to work independently in a remote environment. + Ability to work with those in other time zones than your own. **JOB QUALIFICATIONS** **Required Qualifications** + At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. + Policy/government legislative review knowledge + Strong analytical and problem-solving skills + Familiarity with administration systems + Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams + Previous success in a dynamic and autonomous work environment **Preferred Qualifications** + Project implementation experience + Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). + Medical Coding certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. **JOB DUTIES** + Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. + Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. + Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. + Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. + Where applicable, codifies the requirements for system configuration alignment and interpretation. + Provides support for requirement interpretation inconsistencies and complaints. + Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. + Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. + Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. + Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. **KNOWLEDGE/SKILLS/ABILITIES** + Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. + Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. + Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. + Ability to concisely synthesize large and complex requirements. + Ability to organize and maintain regulatory data including real-time policy changes. + Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. + Ability to work independently in a remote environment. + Ability to work with those in other time zones than your own. **JOB QUALIFICATIONS** **Required Qualifications** + At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. + Policy/government legislative review knowledge + Strong analytical and problem-solving skills + Familiarity with administration systems + Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams + Previous success in a dynamic and autonomous work environment **Preferred Qualifications** + Project implementation experience + Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). + Medical Coding certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Recoveries & Disputes * Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. * Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. * Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. * Provide actionable insights and recommendations to leadership to drive continuous improvement. Skills & Competencies * Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. * In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. * Strong understanding of claim system configurations, payment policies, and audit processes. * Exceptional analytical, problem-solving, and documentation skills. * Ability to translate complex business problems into clear system requirements and process improvements. * Proficiency in Excel * Knowledge in QNXT preferred * Strong communication and stakeholder management skills with ability to influence across teams. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. **JOB DUTIES** + Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. + Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. + Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. + Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. + Where applicable, codifies the requirements for system configuration alignment and interpretation. + Provides support for requirement interpretation inconsistencies and complaints. + Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. + Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. + Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. + Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. **KNOWLEDGE/SKILLS/ABILITIES** + Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. + Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. + Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. + Ability to concisely synthesize large and complex requirements. + Ability to organize and maintain regulatory data including real-time policy changes. + Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. + Ability to work independently in a remote environment. + Ability to work with those in other time zones than your own. **JOB QUALIFICATIONS** **Required Qualifications** + At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. + Policy/government legislative review knowledge + Strong analytical and problem-solving skills + Familiarity with administration systems + Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams + Previous success in a dynamic and autonomous work environment **Preferred Qualifications** + Project implementation experience + Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). + Medical Coding certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. **JOB DUTIES** + Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. + Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. + Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. + Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. + Where applicable, codifies the requirements for system configuration alignment and interpretation. + Provides support for requirement interpretation inconsistencies and complaints. + Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. + Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. + Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. + Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. **Recoveries & Disputes** + Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. + Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. + Provide actionable insights and recommendations to leadership to drive continuous improvement. **Skills & Competencies** + Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems into clear system requirements and process improvements. + Proficiency in Excel + Knowledge in QNXT preferred + Strong communication and stakeholder management skills with ability to influence across teams. **KNOWLEDGE/SKILLS/ABILITIES** + Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. + Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. + Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. + Ability to concisely synthesize large and complex requirements. + Ability to organize and maintain regulatory data including real-time policy changes. + Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. + Ability to work independently in a remote environment. + Ability to work with those in other time zones than your own. **JOB QUALIFICATIONS** **Required Qualifications** + At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. + Policy/government legislative review knowledge + Strong analytical and problem-solving skills + Familiarity with administration systems + Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams + Previous success in a dynamic and autonomous work environment **Preferred Qualifications** + Project implementation experience + Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). + Medical Coding certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Recoveries & Disputes * Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. * Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. * Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. * Provide actionable insights and recommendations to leadership to drive continuous improvement. Skills & Competencies * Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. * In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. * Strong understanding of claim system configurations, payment policies, and audit processes. * Exceptional analytical, problem-solving, and documentation skills. * Ability to translate complex business problems into clear system requirements and process improvements. * Proficiency in Excel * Knowledge in QNXT preferred * Strong communication and stakeholder management skills with ability to influence across teams. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. **KNOWLEDGE/SKILLS/ABILITIES** + Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems. + Participates in defect resolution for assigned component + Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. + Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. + Participates in the implementation and conversion of new and existing health plans. + Must have experience in Contracts configuration in QNXT or Networx + Experience in DOFR (division of financial responsibility) or CA DOFR, DME, capitation, Physician pricing is required. + Must have knowledge on Medicare payment methods + Experience on Hospital payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is required + Medicaid and Duals experience is highly preferred **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree or equivalent combination of education and experience **Required Experience** 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. **Preferred Education** Graduate Degree or equivalent experience Medicaid and Duals expeirence is preferred. **Preferred Experience** 7-9 years To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Serves as a subject matter expert on system capabilities, conducting research and root cause analysis to resolve complex business and technical issues. Ensures system configuration aligns with business rules, regulatory requirements, and operational needs. Supports upgrades, releases, and health plan implementations while validating data integrity and recommending improvements to enhance system efficiency and quality. **KNOWLEDGE/SKILLS/ABILITIES** + Serves as a subject matter expert (SME) on NetworX system capabilities, leveraging system knowledge to evaluate configuration options and recommend optimal solutions + Must have configuration experience in NetworX Pricer + Conducts in-depth research and analysis to identify root causes of complex business and system issues, providing clear recommendations for resolution + Participates in defect resolution for assigned component + Designs and facilitates system knowledge training sessions to improve user understanding and operational efficiency + Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. + Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. + Participates in the implementation and conversion of new and existing health plans. + Must have healthcare experience. + Experience working with SQL is highly preferred. **JOB QUALIFICATIONS** **Required Education** + Bachelor's Degree or equivalent combination of education and experience **Required Experience** + 5-7 years of provider contract configuration experience **Preferred Education** + Graduate Degree or equivalent experience **Preferred Experience** + 7-9 years provider contract configuration experience + SQL Experience (HIGHLY PREFERRED) + NetworX Pricer experience (HIGHLY PREFERRED) To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. KNOWLEDGE/SKILLS/ABILITIES * Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems. * Participates in defect resolution for assigned component * Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. * Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. * Participates in the implementation and conversion of new and existing health plans. * Must have experience in Contracts configuration in QNXT or Networx * Experience in DOFR (division of financial responsibility) or CA DOFR, DME, capitation, Physician pricing is required. * Must have knowledge on Medicare payment methods * Experience on Hospital payment methodology & processing is essential * Understanding on hospital claims processing and configuration works * Medicare fee schedule knowledge is required * Medicaid and Duals experience is highly preferred JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent combination of education and experience Required Experience 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. Preferred Education Graduate Degree or equivalent experience Medicaid and Duals expeirence is preferred. Preferred Experience 7-9 years To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $141,371 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Serves as a subject matter expert on system capabilities, conducting research and root cause analysis to resolve complex business and technical issues. Ensures system configuration aligns with business rules, regulatory requirements, and operational needs. Supports upgrades, releases, and health plan implementations while validating data integrity and recommending improvements to enhance system efficiency and quality. KNOWLEDGE/SKILLS/ABILITIES * Serves as a subject matter expert (SME) on NetworX system capabilities, leveraging system knowledge to evaluate configuration options and recommend optimal solutions * Must have configuration experience in NetworX Pricer * Conducts in-depth research and analysis to identify root causes of complex business and system issues, providing clear recommendations for resolution * Participates in defect resolution for assigned component * Designs and facilitates system knowledge training sessions to improve user understanding and operational efficiency * Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. * Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. * Participates in the implementation and conversion of new and existing health plans. * Must have healthcare experience. * Experience working with SQL is highly preferred. JOB QUALIFICATIONS Required Education * Bachelor's Degree or equivalent combination of education and experience Required Experience * 5-7 years of provider contract configuration experience Preferred Education * Graduate Degree or equivalent experience Preferred Experience * 7-9 years provider contract configuration experience * SQL Experience (HIGHLY PREFERRED) * NetworX Pricer experience (HIGHLY PREFERRED) To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $141,371 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.